I (25 Y/o Male) Have Had Chronic Rectal Bleeding (red

Posted on Wed, 6 Mar 2019

Question: I (25 y/o male) have had chronic rectal bleeding (red blood on the paper and occasional dripping) when I poop for months (so far, 7 months) and nothing I'm doing is resolving the issue. I have used Miralax, which has relieved the bleeding only for as long as I've taken them, but once I am off of them, the bleeding continues. Recently, I was on Miralax for a whole month, and once I stopped to see if it resolved, I bleed when I passed normal sized stool. I recently had a sigmoidoscopy where my doctor said he found two skin tags but told me that they were not worth taking out and he would not be able to help since they were below the pectinate line. I'm not sure if my gastroenterologist really knows what is going on with me or is underestimating my case. I can provide additional information on my issue but what steps can I take or doctors could I see for further assistance?

Answered by Dr. Vasudha (3 hours later)

Brief Answer:
Need life style changes & consultation of a Proctologist.

Detailed Answer:
Hi,Holdenlee56,
Thank you for the query...I understand your concern.
Long standing bleeding while passing stools could be bleeding piles.They are either genetic or result of wrong life style....and represent dialated & inflammed blood vessel in rectal canal.
*You have a pile below pectineal line... that separates upper two third and lower one third of rectal canal. The anotomical details are different in these parts. lower one third has more nerve supply and so is more likely to be painful ...also needs an expert while treating it surgically.
*You therefore need to consult a Proctologist (expert in anal surgeries) for it.Treatment would be antibiotic,anti inflammatory drugs,laxatives to avoid rubbing of hard stools on piles & bleeding, hemostatic drugs/local injections to reduce inflammation &fibrose the blood vessel to stop bleeding OR removal of piles by surgery.
* life style changes like having regular bowel habits,/eating more finbers & plenty of water in diet, reduce weight ,have active life style,do regular daily exercises including those for abdominal & anal canal /have stress-free motion, avoid regular weight lifting . coughing or straining.
With changed life style & expert advise &treatment, you would overcome the problem.
I hope that helps you.Any more information you want,please ask me . I would like to help you.
Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vasudha (37 minutes later)

Thank you for the advice. I should have added details prior but I have been physically fit prior to the onset of my symptoms. As an example, I do distance running (4-5 times a week) and occasional half-marathons/other races during the fall/spring semesters. I have also had no other significant symptoms, such as abd issues/pain or N/V/D, or medical/family history. The only notable issue that I had many months ago involved a period of constipation when I was extensively studying for my MCAT, but I am unsure if that is completely relevant to having continued bleeding despite efforts to resolve it. Fortunately, I actually am scheduled to meet with a surgeon, this Friday (possibly, general but I am unsure of his specialty). Since I am so unsure as to why I am continuing to bleed despite taking stool softeners/implementing higher fiber diets for so long, I wanted to understand how necessary a surgical intervention/solution may be. I, myself, am a medical student (M1), so I want to be coordinate with my surgeon in the best possible way. Thanks for the advice. If have anything further to add based on what I've written, could you let me know? Thank you.

Answered by Dr. Vasudha (4 hours later)

Brief Answer:
Running itself may be instigating factor.

Detailed Answer:
Hi Holdenlee56,
Thank you for the follow up query
IHappy to know a would be medico... who is well versed with the basic life style pattern to control bleeding piles...
As you know piles form a coushen of bulged blood vessels on the inner lining of rectal/anal canal... which tends to bleed when inflammed &irritated/traumatised .
Though you are taking all the lifestyle precautions &stool softeners to prevent bleeding.... one point has not be considered....irritation or straining rectum while doings tremulous work outs or nunning long distance (5 times in a week)itself can cause continuous stress to (lower most par of our body....)rectum &anus..irritating the mucus membrane... keeping it inflammed &easily roughened by even smoothened stools!
I feel you need to change your exercising pattern...without putting strain on rectum.
You seem to be attached to a medical institute.. where you can easily meet a rectal surgeon... please get it corrected surgically.. if it must(depends on site &grade of the piles)... &have a riddle less happy life ahead!
Hope that helps.Any follow up query is welcome!
Thanks.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj